Like many of this site's readers, I've been totally preoccupied by the debate surrounding health care reform over the past few months, and increasingly disappointed that we'll really get anything near the type of reform we, as a country, need.  While recently twiddling my thumbs and bemoaning the fact that the single payer idea has gotten no attention whatsoever, however, I stumbled upon an idea that seemed like a good reason why the right might actually support a single payer system (yeah right, keep dreaming).

Anyway it goes like this:  I'm a lawyer by trade, and have worked in the past in the personal injury defense field, and have more recently dabbled in medical malpractice (plaintiff side).  I do mostly commercial and business litigation, but sometimes, my firm's business clients have other legal needs where we can be of assitance, but I digress.  In the personal injury and medical malpractice fields, damage awards generally consist of economic and non-economic damages.  Typically, although not always, the largest component of an economic damages award are the past and future medical bills (whether paid for by insurance or not, as insurers usually have lien rights against any recovery).  These "hard and fast" numbers are often what set the expectations of total recovery or exposure in a case.  For example, a small accident where one goes to a doctor once and then just deals with the pain for a short period, and incurs only $200 in medical bills, just will not settle for more than a few hundred, maybe a few thousand, dollars.  The same accident, however, accompanied by a course of treatment with a chiropractor for 5-6 weeks and resulting in bills of $5,000 is far more likely to settle for $10,000 - $15,000.  None of this is set in stone, mind you, but insurance adjusters, at least for the most part, view their world this way.

What would happen if all these bills were paid through a sungle payer health care system?  In other words, if you never got a bill and never knew or cared how much the care in question cost you, how would you be able to include it as part of a damages calculation?  What would happen in that case is you'd be forced to go to trial seeking wage loss, dimished earning capacity, and pain and suffering only.  A huge component of your case (to which you had no entitlement anyway, but which increased the value of everything else) would be gone.  There'd be no more awards for future medicals, as they'd be borne by the system without recourse.

Now, admittedly, without changes, this would break down a bit when we got to the point of the single "payor" seeking subrogation against the wrongdoer, but my guess is that we could work out a good system to allow this to proceed on a parallel-type track, unencumbered by notions of the victim's responsibility for a medical lien.  

In my opinion, removing what is often the largest element of a PI or medical malpractice case from the equation, and which normally doesn't belong to the injured party anyway, would tend to reduce the settlement and jury verdict value of a number of these cases, and would altogether eliminate those cases where a small settlement would otherwise have been appropriate but for a plainitff's overtreatment for purposes of pumping up value.

Just sayin'.